This study investigates whether the HIV/AIDS and Life Skills Education Programme for schools was implemented in accordance with the Ministry's directives. It also seeks to establish whether the programme was effective or not by identifying and examining different implementation strategies and methodologies. Fieldwork was undertaken in the Lupane Area Development Programme where nine schools were randomly selected from sixteen primary schools. A total of nine head-teachers responded to the heads' questionnaire and fifty-eight Grade 4 to 7 teachers responded to the teachers' questionnaire. The study reveals that to a very large extent the HIV/AIDS and Life-skills Education Programme was implemented from Grades 4 to 7 in the primary schools. However, substantial improvements still need to be made in mobilising reading and financial resources. More training and the introduction of more participatory methodologies need to be stepped up for the children to realise more benefits from this life skills education programme. / Development Studies / M.A. (Development Studies)

Le complexe Burkholderia cepacia (Bcc) englobe 17 espèces retrouvées dans les infections pulmonaires d'individus atteints de mucoviscidose. Les bactéries de ce complexe sont présentes dans les sols, la rhizosphère de grandes cultures, les eaux usées et peuvent également être rencontrées dans le cadre d'infections nosocomiales. En France, les espèces B. multivorans et B. cenocepacia (Bcen) sont les espèces majoritaires au niveau des infections de patients atteints de mucoviscidose. Divers clones épidémiques ont été décrits au sein de l’espèce Bcen dont le clone ET12 associé au "syndrome cepacia". En 2004, une épidémie nosocomiale impliquant un clone du Bcc est survenue dans un hôpital de l’Ain. Durant ce travail, l’origine de ce clone (B&B), sa classification au sein du Bcc et certains phénomènes génétiques liés à son émergence ont été étudiés. Cela a permis d’identifier ce clone comme appartenant à l’espèce Bcen et une forte proximité de celui-ci avec la lignée ET12. L’étude des facteurs transcriptionnels de la famille σ70 au sein du Bcc a mis en évidence une structure génétique similaire entre la lignée ET12 et ce clone, mais différente de celle observée chez les autres espèces du Bcc. L’analyse d’éléments génétiques répétés de la famille des séquences d’insertion (IS) a cependant permis d’observer une organisation génomique distincte de la lignée ET12. Celle-ci a été reliée à des phénomènes d’instabilité génétique notamment à des phénomènes d’acquisition d’éléments génétiques mobiles de type îlot génomique. L’ensemble de ce travail a permis de caractériser un ensemble de phénomènes génétiques pouvant expliquer l’émergence de clones épidémiques tels que le clone B&B. / The Burkholderia cepacia complex (Bcc) comprises 17 species found in lung infections of individuals with cystic fibrosis. The bacteria of this complex are present in the soil, the rhizosphere of field crops, wastewater and may also be encountered in nosocomial infections. In France, the B. multivorans and B. cenocepacia species are the major species in infections of cystic fibrosis patients. Various epidemic clones have been described within the B. cenocepacia species whose ET12 clone associated with "cepacia syndrome". In 2004, a nosocomial outbreak involving a clone of Bcc occurred in a French hospital. During this outbreak, origin of this clone (B&B clone), its classification within the Bcc and several genetic events associated with its emergence have been studied. These investigations have identified this clone as belonging to the species B. cenocepacia with a strong proximity with the ET12 lineage. The study of transcriptional factors of σ70 family within the Bcc has revealed a similar genetic structure between the ET12 lineage and this clone, but different from that observed in other species of Bcc. Analysis of genetic elements repeated family of insertion sequences (IS), however, allowed to observe a distinct genomic organization of the ET12 lineage. It has been linked to phenomen of genetic instability including acquisition of mobile genetic elements like genomic island (GI). All of this work has helped to characterize a set of genetic events may explain the emergence of epidemic clones such as clone B&B.

L’allocation des ressources spectrales à des services de communications sans fil, sans cesse plus nombreux et plus gourmands, a récemment mené la communauté radio à vouloir remettre en question la stratégie de répartition des bandes de fréquences imposée depuis plus d’un siècle. En effet une étude rendue publique en 2002 par la commission fédérale des communications aux Etats-Unis (Federal Communications Commission - FCC) mit en évidence une pénurie des ressources spectrales dans une large bande de fréquences comprise entre quelques mégahertz à plusieurs gigahertz. Cependant, cette même étude expliqua cette pénurie par une allocation statique des ressources aux différents services demandeurs plutôt que par une saturation des bandes de fréquences. Cette explication fut par la suite corroborée par de nombreuses mesures d’occupation spectrale, réalisées dans plusieurs pays, qui montrèrent une forte sous-utilisation des bandes de fréquences en fonction du temps et de l’espace, représentant par conséquent autant d’opportunité spectrale inexploitée. Ces constations donnèrent naissance à un domaine en plein effervescence connu sous le nom d’Accès Opportuniste au Spectre (Opportunistic Spectrum Access). Nos travaux suggèrent l’étude de mécanismes d’apprentissage pour la radio intelligente (Cognitive Radio) dans le cadre de l’Accès Opportuniste au Spectre (AOS) afin de permettre à des équipements radio d’exploiter ces opportunités de manière autonome. Pour cela, nous montrons que les problématiques d’AOS peuvent être fidèlement représentées par des modèles d’apprentissage par renforcement. Ainsi, l’équipement radio est modélisé par un agent intelligent capable d’interagir avec son environnement afin d’en collecter des informations. Ces dernières servent à reconnaître, au fur et à mesure des expériences, les meilleurs choix (bandes de fréquences, configurations, etc.) qui s’offrent au système de communication. Nous nous intéressons au modèle particulier des bandits manchots (Multi-Armed Bandit appliqué à l’AOS). Nous discutons, lors d’une phase préliminaire, différentes solutions empruntées au domaine de l’apprentissage machine (Machine Learning). Ensuite, nous élargissons ces résultats à des cadres adaptés à la radio intelligente. Notamment, nous évaluons les performances de ces algorithmes dans le cas de réseaux d’équipements qui collaborent en prenant en compte, dans le modèle suggéré, les erreurs d’observations. On montre de plus que ces algorithmes n’ont pas besoin de connaître la fréquence des erreurs d’observation afin de converger. La vitesse de convergence dépend néanmoins de ces fréquences. Dans un second temps nous concevons un nouvel algorithme d’apprentissage destiné à répondre à des problèmes d’exploitation des ressources spectrales dans des conditions dites de fading. Tous ces travaux présupposent néanmoins la capacité de l’équipement intelligent à détecter efficacement l’activité d’autres utilisateurs sur la bande (utilisateurs prioritaires dits utilisateurs primaires). La principale difficulté réside dans le fait que l’équipement intelligent ne suppose aucune connaissance a priori sur son environnement (niveau du bruit notamment) ou sur les utilisateurs primaires. Afin de lever le doute sur l’efficacité de l’approche suggérée, nous analysons l’impact de ces incertitudes sur le détecteur d’énergie. Ce dernier prend donc le rôle d’observateur et envoie ses observations aux algorithmes d’apprentissage. Nous montrons ainsi qu’il est possible de quantifier les performances de ce détecteur dans des conditions d’incertitude sur le niveau du bruit ce qui le rend utilisable dans le contexte de la radio intelligente. Par conséquent, les algorithmes d’apprentissage utilisés pourront exploiter les résultats du détecteur malgré l’incertitude inhérente liée à l’environnement considéré et aux hypothèses (sévères) d’incertitude liées au problème analysé. / During the last century, most of the meaningful frequency bands were licensed to emerging wireless applications. Because of the static model of frequency allocation, the growing number of spectrum demanding services led to a spectrum scarcity. However, recently, series of measurements on the spectrum utilization showed that the different frequency bands were underutilized (sometimes even unoccupied) and thus that the scarcity of the spectrum resource is virtual and only due to the static allocation of the different bands to specific wireless services. Moreover, the underutilization of the spectrum resource varies on different scales in time and space offering many opportunities to an unlicensed user or network to access the spectrum. Cognitive Radio (CR) and Opportunistic Spectrum Access (OSA) were introduced as possible solutions to alleviate the spectrum scarcity issue.In this dissertation, we aim at enabling CR equipments to exploit autonomously communication opportunities found in their vicinity. For that purpose, we suggest decision making mechanisms designed and/or adapted to answer CR related problems in general, and more specifically, OSA related scenarios. Thus, we argue that OSA scenarios can be modeled as Multi-Armed Bandit (MAB) problems. As a matter of fact, within OSA contexts, CR equipments are assumed to have no prior knowledge on their environment. Acquiring the necessary information relies on a sequential interaction between the CR equipment and its environment. Finally, the CR equipment is modeled as a cognitive agent whose purpose is to learn while providing an improving service to its user. Thus, firstly we analyze the performance of UCB1 algorithm when dealing with OSA problems with imperfect sensing. More specifically, we show that UCB1 can efficiently cope with sensing errors. We prove its convergence to the optimal channel and quantify its loss of performance compared to the case with perfect sensing. Secondly, we combine UCB1 algorithm with collaborative and coordination mechanism to model a secondary network (i.e. several SUs). We show that within this complex scenario, a coordinated learning mechanism can lead to efficient secondary networks. These scenarios assume that a SU can efficiently detect incumbent users’ activity while having no prior knowledge on their characteristics. Usually, energy detection is suggested as a possible approach to handle such task. Unfortunately, energy detection in known to perform poorly when dealing with uncertainty. Consequently, we ventured in this Ph.D. to revisit the problem of energy detection limits under uncertainty. We present new results on its performances as well as its limits when the noise level is uncertain and the uncertainty is modeled by a log-normal distribution (as suggested by Alexander Sonnenschein and Philip M. Fishman in 1992). Within OSA contexts, we address a final problem where a sensor aims at quantifying the quality of a channel in fading environments. In such contexts, UCB1 algorithms seem to fail. Consequently, we designed a new algorithm called Multiplicative UCB (UCB) and prove its convergence. Moreover, we prove that MUCB algorithms are order optimal (i.e., the order of their learning rate is optimal). This last work provides a contribution that goes beyond CR and OSA. As a matter of fact, MUCB algorithms are introduced and solved within a general MAB framework.

Syfte: Studiens syfte är att analysera huruvida korruption i biståndsprocesser bättre kan hanteras via de blockkedjebaserade lösningarna kryptovalutor, smarta kontrakt och tokens, jämfört med traditionellt biståndsgivande. Vidare ämnar studien applicera resultaten från fallstudien på generella avtalsprocesser exponerade mot opportunism, för att analysera huruvida de blockkedjebaserade lösningarna bättre kan hantera transaktionskostnader jämfört med traditionella avtalslösningar. Bakgrund: Informationsasymmetrier, begränsad rationalitet och strategiskt beteende resulterar i tillitsproblematik vid avtalsprocesser, vilket ökar transaktionskostnaderna (Williamson, 1974). Biståndsprocesser är extra exponerade mot opportunistiskt beteende i form av korruption, vilket leder till att en stor del av biståndet försvinner på vägen (Transparency International, 2017). Blockkedjebaserad teknik ger möjligheten att ingå avtal utan tillit till motparten, men  lösningen är inte optimal för alla typer av avtal. Det motiverar en analys om huruvida tekniken kan hantera transaktionskostnader i biståndsprocesser bättre än traditionellt biståndsgivande. Genomförande: Studiens primärdata inhämtades via semi-strukturerade intervjuer med två svenska biståndsorganisationer och två experter inom blockkedjetekniken. Utöver intervjuerna genomfördes även en litteraturstudie och den insamlade empirin analyserades utifrån ett transaktionskostnadsperspektiv. Slutsats: Blockkedjebaserade lösningar kan hantera transaktionskostnader bättre än traditionellt biståndsgivande när Greenspans (2015) fem kriterium är uppfyllda. Kontexten, avtalets karaktär och avtalsparternas preferenser är de avgörande faktorerna huruvida kriterierna uppfylls i såväl biståndsgivande som generella avtalsprocesser. En ökad transparens, öppenhet och censurresistens måste värderas högre vid implementering än de medföljande säkerhetsriskerna. / Purpose: The purpose of this study is to analyze whether corruption in aid processes better can be managed through the blockchain-based solutions cryptocurrencies, smart contracts and tokens, in comparison to traditional donation of aid. The study also aims to apply the results from the case study to general contractual processes exposed to opportunistic behavior, to analyze whether the blockchain-based solutions better can manage the transaction costs in comparison to traditional contractual solutions. Background: Asymmetric information, bounded rationality and strategic behavior result in trust issues in contractual processes, which increases transaction costs (Williamson, 1974). Aid processes are particularly exposed to opportunistic behavior in form of corruption, which leads to aid disappearing on the way (Transparency International, 2017). Blockchain-based technology enables contractual relationships without trusting the counterpart, but is not an optimal solution for all types of contracts. This provides incentives for a further analysis whether the technology can manage transaction costs in aid processes better than traditional donation of aid. Completion: The study´s primary data was obtained through semi-structed interviews with two Swedish aid organizations and two experts in blockchain technology. A literature review was made and the empirical data was analyzed from a transaction cost perspective. Conclusion: Blockchain-based solutions can manage transaction costs better than the traditional donation of aid when Greenspan´s (2015) five criteria is met. The context, the characteristics of the contract and the preferences of the contracting parties are the decisive factors whether the criteria are met in the aid donation process and in general contractual processes. Increased transparency, openness and censor resistance must be valued higher when implementing the technology than the following security risks. / <p>Bilagor är inkluderade</p>

A colonização nasal por Staphylococcus aureus e a infecção pelo HIV representam problemas de saúde pública de preocupação mundial. O objetivo geral foi identificar os fatores de risco para a colonização nasal por Staphylococcus aureus em pessoas vivendo com HIV/aids. Para tanto, foi realizado um estudo tipo caso-controle, com pessoas vivendo com HIV/aids internadas nas unidades especializadas na assistência às doenças infecciosas de um hospital de ensino no interior paulista. A coleta de dados ocorreu de janeiro/2013 a fevereiro/2015, por meio de entrevista individual contemplando dados sociodemográficos e clínicos, além da coleta da secreção nasal com auxílio do swab em meio Stuart, ambos nas primeiras 24 horas de internação. As amostras foram encaminhadas e processadas pelo Laboratório de Microbiologia da própria instituição. Os critérios de inclusão foram: ter idade acima de 18 anos, ser soropositivo ao HIV, estar internado. Nas análises estatísticas foram realizados os testes qui-quadrado de Pearson, Exato de Fisher, t-Student, Wilcoxon e Regressão Logística Univariada e Multivariada, por meio do software SAS®. Os dados estão apresentados em tabelas e figuras. O presente estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto (No CAAE 38990114.5.0000.5393) e pela instituição co-participante (No CAAE 38990114.5.3001.5440). Participaram do estudo 240 pessoas vivendo com HIV/aids, sendo 120 Casos e 120 Controles, houve predominância do sexo masculino em 65,0% dos Casos e 55,0% dos Controles, 35,8% dos Casos estavam na faixa etária de 30 a 39 anos e 45,8% dos Controles tinham idade de 40 a 49 anos, a etnia predominante foi a branca para Casos e Controles, 74,2% e 64,2%, respectivamente. Os grupos foram homogêneos entre si em relação ao sexo, etnia e escolaridade. A média do tempo de diagnóstico foi de 9 anos para Casos e 8,8 anos para Controles. O modelo final de regressão logística evidenciou como fatores de risco associados à colonização nasal por Staphylococcus aureus em pessoas vivendo com HIV/aids, ser da etnia branca, p=0,05 (OR:1,85; IC95% 1,00 - 3,57); ter carga viral >40 cópias/mL, p= 0,03 (OR: 2,90; IC95% 1,15 - 7,30); estar com contagem de LT-CD4+ <200 células/mm3 p=0,001 (OR: 2,71; IC95% 1,53 - 4,81); e apresentar doença oportunista p=0,014 (OR: 2,09; IC95% 1,20 - 3,67). Além disso, foi evidenciado como fator de proteção para a colonização nasal pelo Staphylococcus aureus em pessoas vivendo com HIV/aids o uso de antirretroviral p=0,008 (OR: 0,45; IC95% 0,25 - 0,81). Concluímos que a colonização nasal por Staphylococcus aureus nas pessoas vivendo com HIV/aids foi associada aos fatores: etnia, carga viral, contagem de LT-CD4+ , infecção oportunista e uso de antirretroviral / Staphylococcus aureus nasal colonization and HIV infection represent public health problems of global concern. The overall objective was to identify the risk factors for nasal colonization by Staphylococcus aureus in people living with HIV / AIDS. Therefore, a case-control study was conducted, with people living with HIV / AIDS hospitalized at the units specialized in infectious disease care at a teaching hospital in the interior of São Paulo. Data were collected from January / 2013 to February / 2015 by means of an individual interview, including sociodemographic and clinical data, as well as the collection of nasal secretions with the aid of swab in Stuart\'s medium, both during the first 24 hours of hospitalization. The samples were sent and processed by the Laboratory of Microbiology of the institution itself. The inclusion criteria were: to be over 18 years of age, to be known as infected HIV, to be hospitalized. Statistical analyzes were performed using the Pearson chi-square test, Fisher\'s exact test, Student t-test, Wilcoxon test, and Univariate and Multivariate logistic regression using the SAS® software. The data are presented in tables and figures. The present study was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing (CAAE 38990114.5.0000.5393) and by the co- participating institution (CAAE 38990114.5.3001.5440). A total of 240 people living with HIV / AIDS participated in the study, of which 120 were Cases and 120 Controls; 65.0% of Cases and 55.0% of Controls were male: 35.8% of Cases were in the age group of 30 at 39 years and 45.8% of the Controls were aged from 40 to 49 years, the predominant ethnicity was white for Cases and Controls, 74.2% and 64.2%, respectively. The groups were homogeneous among themselves in relation to gender, ethnicity and schooling. The mean time of diagnosis was 9 years for Cases and 8.8 years for Controls. The final logistic regression model showed that the risk factors associated with Staphylococcus aureus nasal colonization in people living with HIV / AIDS were white, p = 0.05 (OR: 1.85, 95% CI: 1.00 - 3.57); having viral load> 40 copies / mL, p = 0.03 (OR: 2.90; IC95% 1.15 - 7.30); being with LT-CD4+ <200 cells / mm3 p = 0.001 (OR: 2.71; IC95% 1.53 - 4.81); and present opportunistic disease p = 0.014 (OR: 2,09; IC95% 1,20 - 3,67). In addition, it was also obtained by the final regression final model that the use of antiretroviral therapy is a protection factor of p = 0.008 (OR: 0.45; 95% CI 0.25 - 0.81) for nasal colonization by Staphylococcus aureus. We conclude that nasal colonization by Staphylococcus aureus in people living with HIV/AIDS was associated with factors: ethnicity, viral load, LT-CD4+ count, opportunistic infection, and antiretroviral use

In der vorliegenden Arbeit werden praktische Protokolle für spontane drahtlose Multi-Hop Maschennetze vorgestellt, diese betrachten das drahtlose System ganzheitlich und berücksichtigen damit die Besonderheiten des drahtlosen Mediums, wie Fading, Interferenz sowie starke Signaldämpfung aufgrund von Entfernung bzw. Hindernissen. Interferenz ist eine Hauptursache für Paketverlust, Durchsatz und Latenz können durch die gleichzeitige Verwendung mehrerer interferenzfreier Kanäle verbessert werden. In Sensor- bzw. Community-Netzen kommt preiswerte und energiesparende Hardware zum Einsatz, die Verwendung zusätzlicher Antennen bzw. Radios ist deshalb nicht möglich. Andererseits werden aber zukünftige drahtlose Netze eine 100-mal höhere Knotendichte, verglichen mit heutigen Netzen, zeigen. Durch die Ausnutzung der im System inhärent vorliegenden Ressource Nutzer (Multi-User Diversität) werden durch Kooperation virtuelle Multi-Antennen und Multi-Radiosysteme aufgebaut. Aufgrund des großen Abstands zwischen den Knoten erreicht man erstens eine hohe räumliche Diversität und zweitens lassen sich damit auch negative Effekte, wie Interferenz zwischen benachbarten Kanälen, minimieren. Es werden Algorithmen sowohl für die Mediumzugriff- als auch die Routing-Schicht vorgestellt. Da keine spezielle physikalische Schicht notwendig ist, kann IEEE 802.11 verwendet werden. Schließlich kann auch auf die bereits heute verfügbare IEEE 802.11 Hardware, die nur eine Kanalumschaltzeit im Millisekundenbereich erlaubt, zurückgegriffen werden. Die zwei vorgestellten Protokolle eignen sich für Umgebungen mit hoher bzw. geringer Interferenz durch fremde WiFi-Netze. Bezüglich Durchsatz werden moderne Protokolle, wie DSR auf Basis von IEEE 802.11 und ETX-Metrik, um ein Vielfaches übertroffen, außerdem ist die Latenz klein und das TCP/IP-Protokoll kann unverändert verwendet werden. / In this work practical protocols are introduced for spontaneous wireless multi-hop mesh networks which contemplate the wireless system integrally and therefore take into account particular features of the wireless medium, like fading, interference as well as strong signal attenuation due to distance or obstacles. Interference is one of the main causes for packet loss. Throughput and latency can be improved by the simultaneous use of several non-interfering channels. In sensor or community networks inexpensive and energy-saving hardware is used. Additional antennas or radios are impossible therefore; on the other hand future wireless networks will show a 100 times higher node density in comparison with today''s networks, however. By the usage of the resource user (multi-user diversity), that is inherently present in the system virtual multi-antennas and multi-radio systems can be built up by cooperation. Firstly, a high spatial diversity can be achieved due to the large distance between the nodes and secondly, negative effects like interference can be minimized between neighboring channels. Algorithms are introduced both for medium access and routing layer. Since a special physical layer is not required IEEE 802.11 can be used. These days already available 802.11 hardware, which allows a channel switching time in milliseconds, is finally usable. The two protocols introduced here are suitable for environments with a high or low interference caused by foreign WiFi networks. Regarding their performance modern protocols like DSR based on 802.11 and ETX metric are surpassed by far. Moreover, the latency is small and the TCP/IP protocol can be used in its unchanged form.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2016-07-06T14:36:10Z No. of bitstreams: 1 arlindosjunior_dissert.pdf: 1444679 bytes, checksum: 3c39df3ac849b54a266ccc0a6c1cc238 (MD5) / Made available in DSpace on 2016-07-06T14:36:10Z (GMT). No. of bitstreams: 1 arlindosjunior_dissert.pdf: 1444679 bytes, checksum: 3c39df3ac849b54a266ccc0a6c1cc238 (MD5) Previous issue date: 2010-11-25 / Hereby we present the epidemiological and clinical profile of the HIV-infected group before and during the HAART era from a tertiary care hospital catering to a large population from the Southeastern Brazilian region. A retrospective, cross-sectional and descriptive study was carried out, which involved the analysis of the medical records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the municipality of Catanduva, State of São Paulo, Brazil. In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were the risk facts for acquisition of the disease in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic illness (OI) was lower in the HAART period. Among all these OI it is worth mentioning pulmonary pneumocystosis, since despite being frequent in the two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OI according to the HIV-1 viral load and serial count of T CD4+ lymphocytes, a significant association was observed. The association between the number of deaths by OI and the survival rate of less than 1 year in the HAART period was significant. The clinical and epidemiological picture of a specialized HIV-1/AIDS Center in a municipality in the southeastern region of Brazil is consistent with the current epidemiology of AIDS in the country. In conclusion, our results indicate that the OI are still important causes of morbi-mortality among HIV-1/AIDS infected patients in the municipality of Catanduva, particularly pulmonary pneumocystosis, tuberculosis and cryptococcal meningoencephalitis. We are aware that retrospective studies such as ours, which involve the review of patients’ medical records, may present some limitations arising from the scarcity or even absence of information. / Nós apresentamos o perfil clínico e epidemiológico de indivíduos portadores do HIV-1 antes e durante a era da terapia antirretroviral altamente ativa (HAART) de um hospital terciário que atende uma grande população da região Sudeste do Brasil. Estudo retrospectivo, transversal e descritivo que envolveu a análise de prontuários dos pacientes diagnosticados com HIV-1/AIDS atendidos no Hospital Escola Emílio Carlos, localizado no município de Catanduva, Estado de São Paulo, Brasil. Em ambos os períodos pré-HAART e HAART, a infecção por HIV-1 foi mais prevalente em homens. Heterossexualidade e nível de escolaridade do ensino médio foram os fatores de risco para aquisição da doença no período HAART. Associação estatisticamente significante foi observada somente para a coinfecção HIV-1/Hepatite C na era pré-HAART e o número de pacientes com infecções oportunistas (IO) foi menor no período HAART. Entre todas estas IO vale à pena mencionar a pneumocistose pulmonar, pois apesar de ser freqüente nos dois períodos, sua ocorrência foi significativamente maior na era pré-HAART. Quanto à distribuição de IO de acordo com a carga viral do HIV-1 e contagem de linfócitos T CD4 +, uma associação significativa foi observada. A associação entre o número de mortes por IO e a taxa de sobrevivência de menos de um ano na era HAART foi significativa. O quadro clínico e epidemiológico de um centro de atendimento especializado em HIV-1/AIDS em um município na região sudeste do Brasil é compatível com a epidemiologia atual da AIDS no país. Em conclusão, nossos resultados indicam que as IO ainda são importantes causas de morbi-mortalidade entre os pacientes infectados por HIV-1/AIDS no município de Catanduva, particularmente a pneumocistose pulmonar, a tuberculose e a meningoencefalite criptococócica. Estamos cientes de que estudos retrospectivos como o nosso, que envolvem a revisão de prontuários médicos, podem apresentar algumas limitações decorrentes da escassez, ou mesmo da ausência de informações.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / ApÃs duas dÃcadas dos primeiros registros da SÃndrome da ImunodeficiÃncia Adquirida (Aids) no Brasil, a assistÃncia à saÃde de pessoas com HIV/Aids ainda à um desafio. Nesse contexto, discute-se a necessidade de efetivar uma polÃtica de atenÃÃo integral a essa populaÃÃo, em especial à saÃde bucal, sendo que o Programa de SaÃde da FamÃlia (PSF) representa uma possibilidade potencial de enfrentamento desse problema. Este estudo tem como objetivo caracterizar as estratÃgias polÃticas e organizacionais da atenÃÃo odontolÃgica a pessoas vivendo com HIV/Aids no MunicÃpio de Fortaleza, CearÃ, e verificar a existÃncia de assistÃncia odontolÃgica na rede bÃsica do MunicÃpio de Fortaleza a pessoas portadoras da doenÃa. A metodologia consistiu, primeiramente, em pesquisa qualitativa documental baseada em revisÃo sistemÃtica da literatura e documentos tÃcnicos do MinistÃrio da SaÃde, do Estado do Cearà e do MunicÃpio de Fortaleza. No segundo momento, optou-se pelo estudo quantitativo, usando como fonte de dados secundÃrios o Sistema de InformaÃÃo de Agravos de NotificaÃÃo - SINAN e, por fim, uma descriÃÃo da realidade por meio da aplicaÃÃo de um questionÃrio a 186 cirurgiÃes-dentistas (CDs) inseridos no PSF de Fortaleza. A anÃlise baseou-se em estatÃstica descritiva, utilizando tabelas e mapas temÃticos para possibilitar uma distribuiÃÃo espacial da doenÃa em Fortaleza, alÃm da anÃlise documental. Encontrou-se pouca documentaÃÃo oficial (polÃticas e diretrizes) relacionada à atenÃÃo a saÃde bucal de pessoas com HIV/Aids, em especial, na esfera federal, que tem como principal material disponÃvel artigos e manuais, em sua maioria, relacionados à biosseguranÃa e a lesÃes bucais oportunistas. No nÃvel municipal, encontrou-se a maior parte da documentaÃÃo oficial. Observou-se que, atà 2007, o nÃmero de pessoas com HIV/Aids vivas residentes em Fortaleza foi de 3.311 e que essas pessoas residem distribuÃdas por todo o MunicÃpio. Constatou-se que mais da metade (58,06%) dos CDs que trabalham no PSF tÃm conhecimento sobre a presenÃa de pessoas portadoras de HIV/Aids, entretanto, apenas 29,57% confirmaram ter atendido essa demanda na unidade onde trabalham. O atendimento odontolÃgico destinado a esse mesmo pÃblico nÃo ocorreu igualmente em todo o municÃpio de Fortaleza, sendo concentrado mais em alguns locais, destacando-se a Secretaria Executiva Regional II. Conclui-se que, apesar do Programa Nacional de DST/Aids ser reconhecido internacionalmente, hà a necessidade de avanÃar na discussÃo sobre a saÃde bucal dessa populaÃÃo e que a assistÃncia odontolÃgica a pessoas com HIV/Aids nÃo està consolidada como aÃÃo de saÃde bucal do PSF, embora jà exista uma polÃtica municipal direcionada para esse fim, indicando a necessidade de reorganizaÃÃo e reorientaÃÃo da assistÃncia odontolÃgica a pessoas com HIV/Aids. / Two decades following the first cases of the Acquired Immunodeficiency Syndrome (Aids) registered in Brazil, health care for individuals living with HIV/Aids is still a significant challenge. Within this context, the need to implement an integrated health policy for this group has been frequently discussed. This is particularly relevant for oral health services, where the Family Health Program (PSF-Programa SaÃde da FamÃlia) offers a potential tool to address this issue. This study has the objective of examining the political and organizational oral health strategies for people with HIV/Aids in the municipality of Fortaleza, Cearà state, and verifying the extent of oral care services in the municipal basic health structure. The methodology consisted of a qualitative and documentary study based on a systematic review of the literature and technical guidelines issued by the Ministry of Health and the secretariats of the State of Cearà and Municipality of Fortaleza. Additionally, the researchers used a quantitative approach using secondary data from the National Notifiable Diseases Health Information System (SINAN - Sistema de InformaÃÃo de Agravos de NotificaÃÃo). Finally, a snapshot of current conditions was taken by means of a questionnaire applied to 186 dental surgeons (DS) working in the PSF in Fortaleza. Analysis was undertaken using descriptive statistics, in particular tables and thematic maps to display the spatial distribution of the disease in Fortaleza, in addition to the literature review. Relatively little official documentation was found (policies and technical guidelines) relative to the oral health services for people living with HIV/Aids, especially at the federal level which only has articles and manuals available, mostly dealing with biosecurity and opportunistic oral lesions. The majority of official documentation was found at the municipal level. The study showed that until 2007, there were 3,311 people living with HIV/Aids in Fortaleza and that these individuals reside throughout the municipality. It was also determined that over half (58.06%) of the DS working in the PSF are aware of the presence of people with HIV/Aids in their working area, yet only 29.57% affirmed that they had treated members of this group in their health unit. The oral health care offered to this group was not equally distributed in the municipality; rather it was concentrated in a few locations, particularly the Executive Secretariat of Region II. It has been concluded that, despite international recognition given to the Brazilian National STD/Aids Program, it is necessary to move forward the debate on oral health services offered to this population group and that the treatment given to people with HIV/Aids has not been consolidated as a key component of oral health services offered by the PSF. This goes against a municipal policy already in existence directed towards this goal, thereby indicating the need for the reorganization and reorientation of the oral health care available to people with HIV/Aids.

HIV (Human Immunodeficiency Virus) has been shown to have significant effects on the development of a child. Currently there is limited South African research regarding HIV and specific characteristics of communication development, and the treatment thereof, in the child infected with HIV. The objective of the research was to describe the communication characteristics of a group of children between the ages of 0 – 5 years infected with HIV at a hospital in Gauteng, South Africa. Clinic records of 203 children infected with HIV between the ages of 0-5 years were reviewed by using a pre-designed checklist within the outreach clinic of a large regional hospital. A questionnaire was completed by 4 medical practitioners working with this population within the outreach clinic. A total of 91.62% of the infected children were diagnosed as being either in Stage III or IV of the disease (according to the WHO classification system of 2005), with all infants presenting with a CD4 count of ≤ 60. The majority (75.37% of the total sample) were receiving HAART (Highly Active Antiretroviral Therapy) at the time the data was collected. According to their medical, social, communication and general development, almost all the children qualified for Early Communication Intervention (ECI) but were not recorded as being referred for such services. A large proportion of the target population presented with opportunistic infections and/or HIV associated conditions. The results highlight the developmental characteristics of children living with HIV, and identify the need for medical doctors and allied health professionals to be provided with relevant literature or training regarding the communication development of children infected with HIV. This will facilitate appropriate referrals for ECI services.

本研究係以裁量性應計數字及其組成成分衡量盈餘管理，以審計人員產業別市場佔有率與產業別客戶集中度之綜合衡量捕捉審計品質，探討不同樣本公司之盈餘管理特性，以及審計品質對不同盈餘管理特性之影響。管理者對應計項目的認列通常有某種裁量權，此裁量權可用以顯露私有資訊而增進盈餘的價值攸關性，或可投機性地管理盈餘而減低盈餘為公司績效衡量的可靠性。所以探究盈餘管理行為是增加財務報告資訊性(information)或雜訊(noise)即非常重要。研究內容依盈餘管理特性區分為投機性盈餘管理與訊息發放性盈餘管理二大部分。每一研究內容則是先辨認盈餘管理本質，其次探討審計品質對盈餘管理之影響。在研究設計上，為避免實證代理變數之衡量誤差重大影響結果，乃採用實驗組公司與控制組配對公司相比較，以凸顯出前者之盈餘管理型態。 　　研究結果顯示，門檻公司從事盈餘管理以達前期盈餘門檻，且此盈餘管理不具未來現金流量持續性之涵義，係符合「隱藏當期不利績效、遞延本期不尋常盈餘至未來年度」以減低會計盈餘數字波動性之特性。就自願性盈餘預測此一資訊揭露工具而言，在盈餘預測偏屬樂觀之傾向下，仍有管理者自願揭露壞消息預期，即可知管理者之誠意，不失為一可資信賴之訊號。但自願預測盈餘增加，則不必然具有高公信力。甚至在管理者降低盈餘差距之動機下，易引起管理者操縱盈餘。此為財務報表使用者所需注意。就持股變動此一資訊揭露工具而言，在我國家族企業居多之情形下，增加持股並未代表任何特定之涵義。反而是減少持股所透露之訊息，值得投資人注意，尤須慎防其盈餘操縱行為。 　　面對增加所得之裁量性應計數字，審計品質有效阻止投機性盈餘管理。面對顯露私有資訊之盈餘管理，審計品質能夠協助管理者選擇最能彰顯未來現金流量預期之會計方法，以增強裁量性應計數字與未來現金流量變動之關聯性。在高審計品質所賦予之資訊公信力下，盈餘資訊在投資人之決策過程中有一定之重要性，故投資人發現裁量性應計數字增加（減低）盈餘價值攸關性，因而增加（減低）盈餘評價係數。然而對低審計品質所查核的財務報表，較低的資訊公信力，使盈餘未在投資人評價過程中扮演重要角色，因而盈餘管理特性亦不受投資人重視。 / This research examined characteristics of earnings management and effects of audit quality therein. Specifically, the magnitude of earnings management was proxied by the discretionary accruals, which are estimated using a cross-sectional version of the Jones model. Different from prior research, the audit quality was captured by a combined measure of the auditor's market share and client concentration. The market share measured the auditor's competence (industry specialty) and the client concentration measured the auditor's independence. Managers usually exercised discretion to recognize accruals. They could either signal private information to enhance earnings' value relevance, or opportunistically manage earnings to reduce the reliability of earnings as the performance measure of the firm. As a result, it was important to examine earnings management and to identify whether it would increase the informativeness or noise of financial reports. This study was organized according to the characteristics of earnings management: opportunistic earnings management and signaling earnings management. For both parts, the nature of earnings management was identified first, and then the effects of audit quality therein examined. To reduce the impact of measurement errors of proxy variables, the treatment group and controlled group were compared and contrasted to make earnings management pattern of the treatment group more evident. 　　The results showed that threshold firms managed earnings to sustain last year's earnings level. Discretionary accruals of the threshold firms were not significantly associated with future cash flow changes. Those discretionary accruals were used to hide the current unfavorable performance, or to defer current unusual earnings to the future, so that managers could reduce the volatility of accounting earnings. As a means of information disclosure, voluntary earnings forecasts tended to be optimistic, but we still could observe some voluntary forecasts which decreased earnings. In those situations, we might conclude that managers tried to convey credible signals. However, it was not necessarily credible in the case of voluntary forecasting which increased earnings. Managers would manipulate earnings to reduce the difference between forecasted earnings and reported earnings. In respect of the information signal of changes in directors' share holding percentages, it signaled nothing when directors increased holding percentages because most companies were family businesses in Taiwan. Nonetheless, investors should look out the possibility of earnings manipulation when directors decreased their holding percentages. 　　Audit quality could effectively deter opportunistic earnings management but not the income-decreasing discretionary accruals. Based on information signaling perspective of earnings management, auditors with higher audit quality tended to assist managers to choose accounting methods that might signal cash flow expectations. Stronger associations between discretionary accruals and future cash flows were observed for firms audited by higher quality auditors. Because higher audit quality might increase information credibility, earnings would play a more important role in the decision process of investors. When discretionary accruals increased (decreased) earnings' value relevance, earnings association coefficients would be increased (decreased). However, for the financial reports audited by lower quality auditors, earnings did not play an important role in the valuation process because of lower information credibility. Therefore, empirical results showed that investors of firms audited by lower quality auditors did not make decisions according to different characteristics of earnings management.